The ratings agency cited the hospital's good market position of in the low 60 percent range, an operating gain of about 1.2 percent in 2013 followed by an operating loss of about $2.9 million for the first part of 2014, and liquidity improvements in 2013 as a result of a letter of credit that was posted following the hospital's settlement regarding the Earl Bradly case. The hospital also has a manageable debt load, according to Fitch.

The hospital completed a transaction June 2 with PNC Bank that would provide $31 million in bonds, which would be used to pay back 2002 bonds and pay for about $15 million in new capital improvement and equipment upgrades, according to Fitch. This debt was not rated by Fitch.

The hospital responded to an increase in competition for ambulatory services by opening similiar facilities in Millsboro, Georgetown and Milton, according to Fitch. It also continues to grow a network that is known as the Beebe Physicians Network.

If the hospital, which is a more than 200-bed facility based in Lewes, is able to increase profitability it could result in a more positive rating, according to Fitch.